Archive for December, 2008

Update on Abby

I was without Internet service much of the day.  Just a quick update – I did finally get Abby to take a bit of sorbet, of all things, late this morning, followed by about half a pedialyte popsicle.  She wouldn't drink most of the day, but she did perk up after those.  She mostly laid in my nanny's lap all day, but that's okay.  She wasn't nearly as feverish or miserable as yesterday.  She's definitely still sick, and still turned down food and drink all day, but had a bit more energy and was willing to suck on a popsicle a few times through the day.  It was enough to keep her happier than she had been, and enough to keep me from dragging her to the ER. 

I'll see how she's doing in the morning.  If she looks worrisome in any way, I'll call the doctor (one of the ones I really like is on call), but otherwise, I will assume she's turned a corner. 

Meanwhile, both Sam and Ellie seemed to take turns for the worse today, but neither are yet showing serious signs of dehydration, so hopefully this is just a temporary setback. 

I am beyond exhausted.  I truly don't think I've been this tired since the early days after the babies were born – and back then I had adrenaline to keep me going.  I really wish I could take a vacation, but I couldn't possibly do that to Seth, or to my beautiful children.  This is part of mommyhood, after all, and I wouldn't trade it for anything.

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Poor Little Abby

I am quite worried about my Abby.  She hasn’t really gotten any better since last week’s puke-fest.  She’s not throwing up as often, but she’s got terrible diarrhea, hasn’t really eaten in days, is barely drinking.  She didn’t pee all day. 

I took her to the doctor this afternoon – not my favorite doctor in the practice, though not my least favorite, either.  Normally, Abby is thrilled when she’s at the doctor all by herself.  She loves to be the singleton.  But she hardly noticed where she was.  Fortunately, once she started getting poked and prodded, she did fight back a little, which is good.  Bad news is she had lost a pound in 7 days.  For a 20 pound baby, that’s pretty significant.  She also had a 102.2F degree fever, despite having given her ibuprofen an hour and a half earlier.

Since she wasn’t COMPLETELY lethargic, the doctor wasn’t too jumpy.  But she IS worried.  Abby hadn’t peed all day, is definitely not herself, and isn’t taking fluids.  She said to give her pedialyte with a dropper if we have to.  If she hasn’t had a wet diaper by morning, I’m to call back to the office.

Seth picked some pedialyte up on the way home, and tried to give her some in a sippy cup, but she was having none of it, so I had him hold her while I gave her little drops of it with a dropper, but she kept spitting it out.  It was close to her bed time, so I paged the doctor to find out how vigilant I needed to be about forcing this into her before bed.  Right after I paged the doctor, Seth suggested trying a pedialyte popsicle, which worked before the doctor called back, thankfully.  She was willing to suck on that. 

The doctor said to do our best to get the whole popsicle into her before bed and then to try to get her to sip on water if she woke up through the night.  And to call her in the morning.

She finished the popsicle, mostly, and we put her to bed.  She went to bed with absolutely no fussing (very unusual for her).  I went into the nursery around 9pm.  Abby opened her eyes and looked at me, but didn’t lift her head and didn’t make a peep.  This is extremely uncharacteristic for her.  Her typical MO is to scream bloody murder if there is an intruder in her room in the middle of the night who isn’t courteous enough to rescue her from her caged prison.  I tried to give her a sippy cup of pedialyte, but she wouldn’t take it.  She wouldn’t even push it away. 

I’m hoping there will be a change in the morning, but my suspicion is that we will be headed back to the doctor in the morning.

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I Could Save The World!

While I wouldn’t wish a catastrophic house fire on anyone, particularly a family with triplets perilously trapped inside the house, I have to say, I have been honored to have been able to work closely with my friends who recently lost their house to fire. I’ve told you about them. It’s been amazing to see how tremendous the efforts to help this family have been. I’ve been proud to be a member of my Parents of Multiples club, and to see how quickly we can come together as a community to help them. I have been overwhelmed with the kindness and generosity of my triplet mom friends from across the country who have pitched in to help. I have watched with wonder as offers of helped, and donations have poured in to help this family rebuild their lives, slowly but surely. It has been unbelievable to be reminded of the goodness of people, of the kindness of strangers and friends alike, and to see how perfectly a system can come together if we try hard enough.

Most amazingly, I am emerging from this with some of the best friends I could ever ask for, which is a bonus I never would have expected. First, the family who lost their home – while I was friends with the mother of the triplets, we knew each other primarily through our parents of multiples group – I am a board member who runs the monthly programs that she attends. Since we both have triplets, we always talk afterward. But now, we have an irreparable bond. Her husband, also, has become what I believe will be a lifelong friend. And her boys – well, they are something special. And many of the other local triplet moms have become much more close in the past several weeks, something which I never really expected. Oddly, while I’m very close with a LOT of triplet moms in the next state over (you know who you are!), I have only a handful of triplet mom friends here in my state/county. And now I’m getting to know all the local triplet moms, which is great. One in particular is now my new BFF and I can’t believe we’ve never been close before, considering how close she lives to me and how easy it would have been for us to have been in touch all through the last year when my kiddos were first born. Better late than never, I say. Now we are inseparable and on the phone/email/facebook constantly. J

And finally, the kindred spirit I’ve mentioned before. Like my BFF Triplet friend, there’s really no explaining the bond I have with this kindred spirit. We had an instant bond from our first email exchange. Because of our involvement in the relief efforts, I swear we exchange at least 600 emails a day and we’re on the phone with each other at least 20 times a day. We finish each other’s sentences. We answer emails from the group email account before the other can get to them. We read each others’ minds. We delegate to each other what we know we wouldn’t trust anyone else to do (the only other person we trust to delegate to? My triplet BFF! Duh!)

Just when I thought my kindred spirit couldn’t get any better, I received a package in the mail yesterday, when I was feeling lower than low. I’d cleaned up more puke and nasty diapers than I knew what to do with. I was feeling gross and I was praying for sleep, but knowing that the monsters angels were unlikely to nap again given that they’d slept for four freakin’ hours that morning (about double their normal morning nap time). I was covered in goo. I was so icky. But I checked the mail anyway in hopes of a pleasant surprise and I got one! There it was, a package. A package with the logo from the company my kindred spirit works for. “That’s funny,” I thought, “My kindred spirit works there…” And lo, and behold, when I opened it up, there was a tiny little box inside with a short note from this dear, sweet woman, whom I have yet to meet face to face – and the most beautiful, perfect, amazing gift I have ever received (well, actually, my four children are the most beautiful, perfect, amazing gifts I’ve ever received, but aside from them…).

A necklace with two pendants: a cape and a tiara. Inscribed on the cape? “I am fairly certain that given a cape and a nice tiara,” and then you turn it over and it says…


“I could save the world!”


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Quit Yer Whinin’

Now, honestly, this here post would have been better off written in the summer, back when the cost of gas was significantly higher, but I was busy, you know? I mean, I’m still busy, but when is that ever going to end? So here’s the thing: I don’t get why people whine about the cost of gasoline. We Americans have it pretty easy, after all. Have you SEEN what a litre of petrol costs in the UK? Seriously, don’t do a google search on that one, because I’m not sure your little hearts can take it (and to my friends in the UK – bless you for not whining about the cost of petrol, because honestly? I’m about sick of hearing about it on this side of the pond). (Okay, I’ll save you the trouble, last I checked it was £1.46 per litre, which if you convert to dollars, then to gallons, carry the 2, account for my bad math skillz, subtract 70, add the cosign of 84, and turn around three times clockwise, I think converts to a little over $8 per gallon, so suck it up Americanos)

Now, here’s something to actually complain about – have you seen the cost of a gallon of MILK? A gallon of whole milk costs $3.75. That’s for plain, boring whole milk. If you want 1% milk, it’s going to run you $3.99. Now, say you want organic milk – now it’s going to cost you $5.79 and up per gallon. That’s for the store-brand organic variety, by the way. No fancy-schmancy organic varieties here. What if, like my husband or the J-man, you can only tolerate lactose-free milk? Well, then you’re looking at $4.39 per half gallon or $5.99 per 96 ounces.

Now seriously – with the cost of gas here in my neighborhood hovering around a dollar and a half per gallon these days – well, I see nothing to complain about. Heck, even when the cost of gas was hovering closer to $4/gallon, I’m not complaining, but that’s because I’m a giving soul who has better things to complain about – like the cost of milk. Honestly, I couldn’t figure out why no one else is complaining about this! I looked in my refrigerator and saw the piles of money staring back at me – mocking me, mostly – and I was mortified. Where does it all go?

And then it hit me – NORMAL people aren’t filling three toddler’s tummies with milk every day. Plus a five year old. Plus a 6’2″ giant. (Me? I don’t drink milk – you couldn’t pay me to touch the stuff) As it happens, the triplets aren’t drinking much milk anymore, not comparatively, anyway. They drink about 10-12 ounces per day, each. But that’s upwards of 36 ounces per day just for the babies. Plus whatever the J-man drinks. Plus whatever Seth drinks. Plus whatever goes into anything I cook with. We’re going through several gallons of milk per week. I’m guessing… that’s probably not normal, is it?



*Note: When I told Seth I was going to write this post, he said I had to look into “milk price supports” which just got me all kinds of confused and made even less sure I understood the whole issue. Suffice it to say, whether or not the government is artificially inflating the cost of a gallon of milk and whether or not it is for good reason IF they are doing so and whether or not that money is doing good things IF they are doing so, well, I’m still whining about the cost of a gallon of milk this week, because, by golly, I can. And next week, I will stop whining about it, because I’m sure I’ll have something better to whine about. I’m sure you all have perfectly good reasons to tell me I shouldn’t be whining about this and blah blah blah. WhatEVER. I don’t feel well and I spent my week getting puked all over. Give a girl a break, will ya?

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Well-Child Visit, My Tushie

Monday Ellie was sick all day – she had started throwing up Sunday night and threw up much of the day on Monday. She wouldn’t drink anything and was screaming a lot, which is unusual for her, so I’d been on and off the phone with the doctor’s office throughout the day. This should have been my first clue that Tuesday’s “well-child visit” wouldn’t be your standard, run-of-the-mill visit. Fortunately, by Tuesday, Ellie was totally fine – a completely happy, healthy baby.

My second clue should have come Tuesday morning when I took the J-man to school. Because my nanny had the day off from work (her father was flying in from Senegal), I packed the triplets into the car and we all took J to school. We traipsed all the way through the building, went down the elevator (have I mentioned that Abby is terrified of elevators? Sheesh!) and over to his classroom. J’s teachers had never met the triplets, so they were really excited to meet them. Then we made the trek back out of the building, which took forever because of all the people who had to stop us to say, “OMGosh are those triplets??!?” Twenty minutes later I finally got to my van, loaded the babies in, climbed into the driver’s seat and saw that I had just missed a call from J’s teacher. I called her back and she said, “You’re not going to believe this, but there’s a water main break somewhere across the county, but they’re shutting off the water in the building, so they’re closing the school right now.” Fortunately, she brought him out to me, rather than making me pack the babies back up and go back in to get him. So this meant taking all four kids to the pediatrician, like we’re not enough of a three-ring-circus as it is. Oy. (To his credit, J was incredibly well behaved at the pediatrician, despite it being over an hour and a half there)

We got to the appointment and the first order of business was to get everyone undressed to be weighed and measured. The good news: Everyone’s growing! J

Sam: 23 lbs. 14 oz. (40th %ile), 31″ long (50th %ile), head circumference 48cm (80th %ile)
Ellie: 22 lbs. 4 oz. (40th %ile), 30.5″ long (50th %ile), head circumference 48cm (85th %ile)
Abby: 21 lbs. 2 oz. (25th %ile), 30.5″ long (50th %ile), head circumference 47 cm (80th %ile)

I noted that I’m really tiring of people telling me that my babies (Sam and Ellie, especially) are fat. People are downright mean about it sometimes. They tell me how huge these babies are. Dr. B. noted that people forget what a baby physique is supposed to look like and said that not only are the babies not fat, but he pointed out that each and every one of them has a weight percentile that is smaller than their length percentile, so they’re doing just fine. He told me to stop listening to other people, and he also reminded me of how hard we worked to get these babies to grow, particularly Ellie. He’s right, of course. J

He asked how Ellie was feeling, since we’d been on the phone so much the day before. “Oh she’s great,” I said, “It’s like she was never sick at all. I don’t know what I was ever worried abo…” and then Abby threw up. Cheese omelets everywhere. Hey, at least Dr. B. knows for sure I’m feeding them a nutritious breakfast, right? Sigh. The hard part was keeping Ellie and Sam from stepping in it, so Dr. B grabbed them, while I worked on cleaning up the mess and cleaning a screaming Abby up. At least she was only wearing a diaper. Once I got the mess somewhat under control, Dr. B. went off to get some wet paper towels and some Lysol to appease the J-man who was complaining about the stench. Dr. B. isn’t fazed by much, and this was no exception. I was mortified, but he barely batted an eyelash. Once everything was cleaned up, we just continued on with the appointment.

Dr. B. asked me what things we needed to talk about and I talked with him about the fact that Abby doesn’t sleep much – she wakes up a lot at night, doesn’t nap much, and screams bloody murder at the sight of her crib. Only if she’s visibly exhausted does she not put up serious protest. “You have to fix it!” I said. We talked about some various methods of working through it, but essentially, Dr. B. thinks that this is largely behavioral, not physical, and that it is likely her version of separation anxiety. He gave me some suggestions for how to approach it, but mostly said that what we are doing is the appropriate approach. So the good doctor doesn’t have ALL the magic answers, but at least he had some validation for the approach we’re already taking, and that’s good enough for me for the moment.

We also talked about the triplets’ language development. Their expressive language development is definitely delayed, but that’s to be expected with multiples, and if you account for the multiple factor, plus factor in their prematurity, we’re not too worried. Their receptive language skills, on the other hand, are much more delayed, which I knew but I hadn’t been sure how much to worry. We already have Early Intervention services for the babies, and when they suggested I have a speech consult for the babies, I said, “Okay, sure, whatever” thinking it was nothing all that worthwhile, but that it couldn’t hurt. They did, indeed, qualify for speech/language therapy, which will start next month, but I still sort of shrugged it off. I told Dr. B. that I let the Early Intervention folks do my worrying for me. I told him that none of what they evaluated the babies for was anything I would have called them for on my own had they not already been involved with the EI program. But, Dr. B. who is anything but an alarmist, and who nearly always prefers to sit back and let normal development happen at its own pace said that this is the point where he would be telling me to get intervention if I hadn’t already. There are a lot of little things that when you put them all together are starting to raise eyebrows, but for now I’ll just leave that all for another post on another day. For now, it sounds like we’re doing the right thing by getting EI Speech Therapy involved and at least we know we’re moving in the right direction.

Ellie and Sam are expert walkers, and though Abby isn’t walking, we know she can walk, but she seems to lack the confidence to do so. Dr. B said that often with early walkers, they just sort of take off without looking back. Ellie and Sam weren’t early per their actual age, but if you factor in their adjusted age, they were a little on the early side. Abby is starting to push the later side, and he said with later walkers, they’re a little older and more aware of the dangers around them, so they’re far more cautious because they’re afraid of falling down if they start walking. He thinks they’re a little delayed with fine motor skills also, but nothing that can’t be accounted for by adjusting their age, so he’s not worried.

He otherwise declared them healthy (puke aside) and asked me how everything was going in general. I said that we are really blessed. We have three easy babies, and the best big brother in the universe. If anyone had been able to adequately convey to me how great this was going to be, maybe I would have freaked out slightly less in the early weeks of my pregnancy. He said that’s a variation on the theme that he hears from a lot of twin moms who say that getting through the first year is so terrible, but that the rewards after that make it all worth it. I don’t feel that the first year was awful at all – I do credit Seth and myself for a lot of it, because I think we did a very good job keeping our lives sane and making sure our babies didn’t overwhelm us, but mostly, we had very easy, perfect babies. Though they had their challenges (especially Ellie with her heart monitor and failure to thrive diagnosis), all in all, they were not the burdens we were prepared for, they have been a joy from the very beginning. And look at them now? Three healthy, beautiful babies toddlers. I reminded Dr. B. how close I came to losing them at 22 weeks. These babies – these babies could have not been here at all. So if my biggest concern today is that their receptive language skills are delayed? Well, then I declare that they are perfect. Dr. B. said that’s a very healthy attitude to have. And on that note, we said goodbye for another three months. At least, I *hope* I don’t see him for another three months!

While I was waiting for the nurse to come in with their vaccinations (just 2 this time), Abby threw up again. This time, she was wearing a shirt, which was ruined, but fortunately, she wasn’t yet wearing pants or socks… I cleaned things up as well as I could. The nurse came in to give everyone their shots and J went out to the waiting room, preferring not to witness such barbaric treatment of his siblings. When the nurse left, I got everyone dressed and Abby threw up again just before I got her into her fleece coat. Sigh. I cleaned it up (AGAIN) and got her back into the stroller bundled up in her coat, and went out to check out and make their next appointment. While I was making the next appointment, Abby threw up again. Sigh. Finally, we got into the car for the 15 minute drive home. We were 12 minutes into the drive when she threw up again, not much this time, because, let’s face it, there wasn’t much left.

I put Abby straight to bed, and put Sam and Ellie into high chairs to feed them a very late lunch and then put them down for a nap also. My mother in law picked up the J-man to take him out of my hair for the afternoon. The babies slept until nearly 5pm when Seth came home. If I’d been more alert, I might have taken this as a clue that something was amiss, but I just figured it was that they’d missed most of their morning nap and gone down later than usual… I got the kids out of bed and we were in the living room when Sam started throwing up. I whisked him off to the bedroom to strip him down and change his diaper so that I could get him into a bath – poor thing, he looked so sad and scared in the bathtub. L I put Sammy into PJ’s and brought him into the dining room where the girls were standing watching Seth work in the kitchen. Suddenly, Ellie threw up. Ellie who had been totally fine for nearly 24 hours! Then we realized that Abby’s diaper smelled like sewage, literally, so I changed her and threw Ellie and Abby into the bathtub and got both of them into PJs and put everybody to bed.

Seth wasn’t feeling great, so he went to lie down. Meanwhile, my mother in law and brother in law, returned the J-man to the house and came bearing presents for Chanukah. So I made Seth get out of bed to come greet everyone. The instant Seth walked into the living room, he turned and ran straight to the bathroom and started throwing up, which woke Ellie up. So I went in and took her out of bed because she was screaming, but I looked over and realized that Sam was sleeping in a pool of vomit, and for good measure, his diaper smelled to high heaven. I calmed Ellie down, took Sam out of his crib, cleaned him off, changed his PJ’s and held him for a while until Seth was well enough to change Sam’s crib. I apologized to my MIL and BIL a few times, and they eventually excused themselves. Clearly this just wasn’t a good night for the Cohens. Sigh. Poor Sam was so tired and sad. J was crying because he was scared about all the throwing up, so I was trying to calm him down also. Finally, I was able to put Sam back in his crib, Ellie calmed down, J realized the world wasn’t ending and I thought everything was fine, but then Abby started screaming – her diaper needed to be changed. Throughout the night, I had to keep checking on the babies, because Sam kept throwing up, but never woke up when he did, so I had to make sure he was okay. I also had to keep changing diapers throughout the night. Finally at 5am, I couldn’t take the crying and I made Seth go up to deal with Abby’s cries, but when I heard they weren’t stopping, I went upstairs to help and realized that there was too much poop and puke for one person to handle. So I dealt with her, while he dealt with changing sheets again. And then I collapsed back into bed.

It was a long and horrific day. Sam got really dehydrated. Ellie kept throwing up. Abby got better and worse again. Ugh. Several phone calls to the doctor’s office. The works. Seth thought he was okay to go to the office, but it turned out, not so much, so he came home early. Today, he had no choice but to go to work, because there was no one to cover his shift. And today, Mommy got sick.

The only one who’s been spared in all this mess is the J-man. Now, here’s an interesting factoid about Norovirus (which is most likely what we have)… people with blood Type A or AB have an inherent immunity to norovirus. Seth and I (and consequently the triplets) are Type O+. We don’t know J’s blood type – but I’m going to place a small wager that it’s A or AB…


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One of the Good Ones

My law school advisor died this month and I just found out.  I missed the funeral, which was 12/15.  I would have liked to have gone to it, despite how I feel about that godforsaken school.  He was one of the few people there that really made me feel like a human being and who treated me with respect and dignity when things were at their worst.  I only spent one year there, but he had an impact on me – he reminded me of some of the goodness left in people and I'm sorry to hear of this sad news.

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A friend of mine delivered her babies yesterday – a set of healthy perfect HOMs. I called my friend, M, to tell her the news. M and I haven’t known each other for all that long, though we emailed a bit after my babies were first born, but recently we’ve become very close. M also has HOMs and did the whole infertility thing, so she gets me. (Though she didn’t do the extensive fertility journey that we did – one IUI and *boom* a set of HOMs!) Anyway, I called her to tell her the news, and I had this funny conversation:

Me: I have exciting news!!!
Her: You’re pregnant!!
Me: Um, no. Not that exciting.
Her: Oh. Really?
Me: Yeah. That would be ironic, actually. I just started birth control pills for an IVF cycle, so wouldn’t THAT be funny? So anyway, no way I’m pregnant.
Her: Birth control pills for an IVF cycle?
Me: Yeah, it’s standard protocol for IVF – it’s part of the suppression cycle in an IVF protocol. I forgot you never did IVF.
Her: So, really? You’re seriously doing this? You really meant it? You’re really having another one?
Me: Yeah!
Her: You know it could be two. Or three. Or… Right?
Me: Oh no. Dr. P. told me I’m not allowed to have two. Or three. Or four. Or…
Her: Yeah, we see how well that worked for you last time. Really? You’re actually starting an IVF cycle?

Sometimes I forget that people don’t realize I’m serious. (not that there are many people in real life that have any clue that we’re doing this…)

So just for the record – We are doing this. For real. I’m not kidding. Though my mental stability has been called into question, so there is that little teeney stumbling block. But aside from that…

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Oh, did I forget to mention CD1? I’ve been a little busy. Wednesday around 4:30pm I discovered that, right on schedule, my period had arrived. Now, I know that I’m still waffling between The Hatchery and the old clinic that has yet to receive a pseudonym (suggestions welcome), but just in case, I’m still proceeding as if The Hatchery is where I’m going until I have my consult with the old clinic.

So, since I’m ever-so-good at following directions (shut UP!), I called the nurse at The Hatchery to let her know it was CD1. Great, she said. They would be having two IVF cycles in January: one starting 1/10 and one starting 1/24, which was I thinking would be better for me. I started to panic about the 1/10 cycle. I’m worried about working out the insurance details by then, and what if I get confusing answers from the old clinic on 1/5 and want to reevaluate? So I told her my schedule was going to be too wacky on 1/10, so let’s go for the 1/24 schedule.

She wasn’t sure the doctor would want to start me on BCPs this early then, because that would mean me being on BCPs for nearly 5 weeks and that could mean me being an under-responder for the cycle. But, she said, aren’t I normally a bit of an over-responder? “I have HOM’s,” I said. Yeah… probably not an issue. She would talk to the doctor and get back to me on Thursday with the plan. The only concern with me just waiting until Jan to get a period on my own is… well, sometimes I just don’t get a period on my own, and that could mean a flurry of bloodwork, provera, hoping the provera works, and probably ending up with a February cycle instead. Not that Feb. vs. Jan. is really the end of the world, but you know how it is. One delay leads to the next delay leads to the next one… Next thing you know, five years, 12 medicated cycles go by and you have a set of HOMs… oh wait, that was last time.

Thursday she got back to me just as I was about to walk into a shiva visit, so I was a bit flustered, but the plan is I’ll start BCPs tonight and take 2 packs (no placebos) until the 23rd when I’ll go in for a baseline ultrasound and start injections on the 24th. Won’t this be fun? We’ll obviously talk plenty between now and then.

So. Um.


My perinatologist had asked me when I saw him on Monday if I thought there might be any possibility that I might have a spontaneous pregnancy to avoid the whole twin possibility – I laughed and said in six years it had never happened (plus, really, with this many kids? who has time for any romancin’ ? JUST KIDDING!). Now I guess our chances of having a spontaneous pregnancy are completely gone, starting tonight.

I know every woman starting an IVF cycle talks about the irony of taking birth control pills in order to get pregnant. I don’t think for me that I find it ironic. I’m struck with a profound sense of – change. This feels like a big step toward my new goal. Toward my new hopes of family building.

I fear that the fall from hope will be devastating.

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Of course you’ve all heard the news. J-ichelle (thanks to Barren for her new name!) Duggar had her 18th baby.

Now, I know you all think I’m crazy, what with the gaggle of kids that I have and wanting to make more. I get that I’m a bit of a sadist. I know that my mental stability has been called into question already this week by a very good perinatologist for considering this (I swear to you, he was joking. I think…). But you certainly canNOT compare me to J-ichelle. Right?

Well, I hope not.

But, that being said, I can’t possibly turn down THIS picture – thanks again to Barren. 🙂

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I saw my Perinatologist today. They’ve totally re-done their offices. I remember that they were doing that when I was in the hospital on bed rest, but I had never seen the result – my post partum follow up was in the other office, so I missed it. The second Dr. P walked in the room, a flood of emotions washed over me, which I didn’t expect. I thought I would be nothing but happy seeing him, which I was, but I was also sad and overwhelmed. How many women have to go to a perinatologist to consider getting pregnant? How many women have ever even SEEN a perinatologist? And here I was, hugging mine, like an old friend. Well, he is an old friend. He went through a lot with me. He saved my babies, more than once.

We chatted for a bit, about our kids, mine and his. Life. Et cetera. “And life is so dull and boring for you that you thought, golly, you’d like to have more, so here you are in my office today,” he segued. I took a deep breath.

So I explained that I’d been to a new RE, that we’d had the discussion about elective single embryo transfers, that this is what I wanted to do, that I don’t want twins. But… of course, the RE I saw had never done elective single embryo transfers. And I wasn’t going to even consider a two-embryo transfer without marching myself into Dr. P’s office and finding out what was in store for me if I found myself pregnant with twins (even though the thinking is that even with a two embryo transfer, odds are that I’d have a singleton implantation – there’s still that risk, so who knows).

He asked how my overall health has been since the pregnancy. It’s been good, actually. My blood pressure is low, I’m down 50+ pounds from my pre-pregnancy weight. My cholesterol/triglycerides are normal, my fasting blood sugar is in the 60’s, I’ve had a few bouts of mastitis and a couple of colds, but that’s about it. Oh, and the migraines suck. But that’s normal for me. He noted that my mental health might not be so stable, but that’s another story…

First, the good news, since my weight is down significantly, my blood pressure risk (e.g. preeclampsia) goes down somewhat. (though I had low blood pressure going into my last pregnancy and still developed preeclampsia (not so surprising giving the HOM factor). Of course, risk of preeclampsia increases with: 1. preexisiting history and 2. multiple gestation … so twin pregnancy would increase the odds.
Bad news, my weight loss will not change my risk of preterm labor, which is obviously the highest risk I’d be facing, particularly with any kind of multiple pregnancy.

So let’s go through this step by step:

Singleton Pregnancy:
He doesn’t forsee any specific problems with a singleton pregnancy per se. He does think that I should limit my activity earlier than most pregnant women. That I shouldn’t lift anything over 10 pounds, even in the first trimester. No picking up my kids, period. I should watch for signs of preterm labor, but he isn’t suggesting that I’m at a serious risk for it, but he knows that I know my body really well and he knows that I’ll know what to look for if a problem does arise. Obviously, any signs of preeclampsia and I’m to tell my doctor immediately. He says no problem on a VBAC. No problem on going to my regular OB for a singleton pregnancy. I can continue taking Topamax – I asked about the risk of cleft palate and he said the research hasn’t panned out, in fact, and he doesn’t think that the risk is really there. If I can reduce my dose, great, but he’s seen people on much higher doses of it, even in the first trimester without any issues and he’s reviewed the literature on it pretty closely. He’ll still see me throughout my pregnancy, concurrently with my regular OB, for monitoring, but doesn’t believe there’s a significant risk associated with a singleton pregnancy, except that I need to reduce my activity sooner than most.

Twin Pregnancy:
Okay, this is where it gets dicey. Let’s come back to this one.

HOM Pregnancy:
Not okay. He would absolutely not recommend I try to have another HOM pregnancy. While mine turned out with a happy ending – I started contracting at 15 weeks, and landed in the hospital at 17 1/2 weeks for contractions. Even with an HOM pregnancy, this is extraordinarily early; very few of his patients experience contractions that early, even with HOM pregnancies. Worse, I wasn’t just having contractions early, I had cervical changes – my cervix went from 4.1cm to 2cm to 1cm in the course of a couple of days. Contractions + Cervical Shortening/Effacement = the technical definition of preterm labor. Not okay. Contractions by themselves are not the enemy. Contractions that affect cervical integrity are.

If I have another HOM pregnancy, I am guaranteed to have early admission to the hospital for the duration. And nearly guaranteed to have preterm labor as badly if not worse than last time. And no guarentees as to outcome. Likely to have repeat preeclampsia. No telling on the cholestemia. No telling on the placenta previa, though the odds are higher with the higher number of multiples. I can kiss a VBAC good bye. He is concerned that I wouldn’t be able to carry HOMs as long as I carried them the first time, but admits he doesn’t have a crystal ball.

Obviously, I’m not seeking to have another HOM pregnancy, but if I were to find myself in another “whoops, it’s HOMs!” situation, he would highly recommend a reduction given my history. This is coming from the man who told me in my last pregnancy that I did not need to reduce – the first doctor in a long procession of doctors who had been telling me that I absolutely had to reduce, who finally told me that I could carry all of my babies. He was right – I did it, and they all, thank heavens, are healthy 15 months later, but it was a long struggle to get there, and no one knows it better than him (except, maybe, me…but actually, I think he knows better than me – he knows more about the medical details of what was going on than I do). While he does do reductions, he does not push for them. He is, primarily, a maternal-fetal specialist. He does not prefer to do reductions when they are avoidable or unneccessary. So… basically, an HOM pregnancy is out. This is fine with me, because if I get pregnant with another set of HOMs, I’ll walk off a bridge.

So what about that Twin Pregnancy?
Okay, so what if I ended up with twins? Again, note that my goal is a singleton. Just as my goal in my last attempt was a singleton. Best laid plans of mice and men, and all. But if I’m faced with a “game day” decision and my RE says to me, “well, we’ve got a bunch of shitty-to-mid-grade embryos, so let’s put back 2-3 embryos instead of just one, shall we?” Do I risk it, knowing that the possibilities are: 1. Neither would implant, resulting in no pregnancy; 2. One would implant and the other wouldn’t, resulting in a singleton pregnancy; 3. They would both implant resulting in a twin pregnancy; or (heaven forbid) 4. one or both could split, they all implant, resulting in an HOM pregnancy with monozygotic multiples. (Odds, of course, are against number 4, so we’ll rule that out for now). So what if we made a game day decision to transfer two and ended up pregnant with twins?

This is where it gets dicier. Dr. P. basically said that I’m looking at a significantly increased risk of preterm labor. I’m likely to start contracting much earlier than typical (many women with twins never experience contractions before they go into labor – but that’s unlikely to be the case with me). I’m unlikely to avoid cervical integrity issues. I’m definitely looking at bed rest, which is not something that he normally tells a woman pregnant with twins from the outset. How realistic is that for someone with four kids and a full time job? he hypothesized
. I said it just couldn’t be done at home. It just couldn’t be. I told him that in my last pregnancy with even just one kid at home, it was a mistake to stay on bed rest at home for so long, and I should have let them admit me – he agreed. (This was not their fault, they left this up to my judgment on what I could handle, and offered to admit me multiple times, and I said I didn’t want to do that to my husband and leave him home with an almost-four year old and a wife in the hospital – now we know for the future that if the hospital is even mentioned, that’s where I go – do not pass go, do not collect $200.) He agreed that if I had a twin pregnancy that when (not if) I went on bed rest, I would likely be admitted outright.

He danced around it a bit, but finally came to the reduction issue. “This would be a much easier discussion if you weren’t totally opposed to the reduction discussion.” And I asked whether reduction was ever even considered for a twin pregnancy. Normally not. And he knows I’m against reduction in general. And he normally would never bring it up if someone walked into his office with a twin pregnancy, and any twin mother that mentions reduction to him gets talked out of it. I finally asked him outright: With my history, if I came to you with a twin pregnancy, what would you tell me to do? While he wouldn’t tell me to reduce outright, with my history, he’d want us to consider it as one of our options on the table. He stressed to me that my height is simply not the only factor that played into my uterine contractions and preterm labor – many other short women with HOMs never have the problems I had. I was the exception to the rule, and I had an exceptionally difficult pregnancy. With a twin pregnancy, while I may not be facing as difficult a time as with an HOM pregnancy, I would likely be facing many of the same risks, would most definitely be facing bed rest, quite possibly in the hospital, and I’d be weighing that against the fact that I have a full time job and a gaggle of kids and how to handle the logistics of all of that. He is not saying I couldn’t carry twins. But he is not convinced that I could carry twins to a safe gestational age without significant bed rest and intervention. And, he asked, is that realistic? Is that fair?

He also knows me. He knows that it’s unlikely we would ever consider a reduction of twins to a singleton.

Bottom Line
So what’s the bottom line? The bottom line is that Dr. P says I’m young enough that I have a high likelihood, even with PCOS, of having high enough quality embryos that I should push hard for elective single embryo transfers, even if I’m being pressured on Game Day to consider two. What he suggested was three cycles with single embryo transfers and if I’m getting nowhere, then consider two. But under no circumstances should I consider more than two. My goal should absolutely be a singleton pregnancy, without question. This, of course, was my goal for personal and financial reasons, but I’ve now confirmed that it must be for medical reasons as well.

There is a piece of me that is a little shell-shocked from today’s appointment. I guess I partly thought I was being a bit alarmist about my pregnancy. I half-expected him to say, “Oh please, Lady! You think you had it rough? You got nothing on most of my patients! You can totally handle a twin pregnancy!” Turns out, he was more serious about avoiding a twin pregnancy than I was. For far more serious reasons.

“I still think you’re a little crazy – but I wish you the best of luck. You know I’m thinking of you and I wish you an uneventful, healthy, singleton pregnancy.”

I am crazy. I know this. But I promised him that if he got to see my gorgeous children every day, he would understand why I want to make more (ONE at a time). He completely understood.

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